Economic Benefit in Treatment of Unintentional Childhood Injuries by Implementation of Child-To-Child Approach.

BACKGROUND: Childhood injury has been recognized as a major threat to child survival and health, as well as economic burden, which includes the cost to government and out-of-pocket expenses (OOPE) to families. Child-To-Child Approach is an innovative technique to reduce childhood injuries and expenses on their treatment. OBJECTIVES: To assess economic benefit in the treatment of unintentional childhood injuries, including OOPE by families, by the implementation of the child-To-Child approach. MATERIALS AND METHODS: The present study is part of a quasi-experimental before-and-after intervention study conducted in the rural area of Delhi for the prevention of childhood injuries through intervention by the child-To-Child approach. Cost of injury treatment, including travel and accommodation expenses, and wage loss were noted. The projected gain in the total cost and out-of-pocket expenditure on injury treatment throughout 20 years of childhood and adolescence were calculated. RESULTS: Both incidences of injuries and total expenditure for treatment of injuries had decreased during the postintervention period in the intervention group, against a rise in the control group. The proportion of OOPE for availing private health care facilities for treatment of injuries, which was more than one-fourth of total expenses, also had decreased in the intervention group during the postintervention period. On economic analysis, it is projected that there will be enormous gain in cost by the implementation of child-To-Child approach in the study area in 20 years, along with saving of OOPE of the families. CONCLUSION: Child-To-Child approach is effective in preventing childhood injuries and reducing the cost of treatment of injuries.

Perception about use of comics in medical and nursing education among students in health professions' schools in New Delhi.

Background: Graphic narratives can give medical and nursing students a broader concept of health and illness. However, graphic texts are not yet integrated into medical education in India. The present study was undertaken to assess the perception of medical and nursing undergraduate students about the use of comics in health professions' education. Methods: This study was an institution-based cross-sectional study conducted among 130 medical and 108 nursing students of a medical and nursing college, respectively, in Central Delhi. A pretested self-administered questionnaire containing items to assess knowledge and perception about graphic medicine in medical education was used for data collection. Data were analyzed using SPSS 16.0. Results: The mean age of students was 20.82 ± 1.51 years. Out of the 238 students, only 21.8% had heard about graphic medicine. However, 76.9% (n = 183) of students agreed that comics should be used in health professions' education. When asked about the subjects in which comic strips can be useful, the majority of medical students wanted them to be used in teaching community medicine (n = 95; 73.1%), while nursing students more often indicated their use in anatomy (n = 59; 54.6%). Overall large proportion of both nursing and medical students opined that comics aid in better understanding (58.8%) and memorization of concepts and content (57.6%). The majority of respondents felt that comic designing requires expertise (67.6%). Students also stated that comic strips on communicable diseases and reproductive and child health could be developed and used in teaching the subject of community medicine/public health. Discussion: Majority of students felt that comics should be used in medical education in India, preferably for teaching community medicine. Further, maternal and child health are important topics that can be taught using comics in public health. There is a need to explore ways for integrating graphic medicine into health professions' education.

Social Security Measures for Elderly Population in Delhi, India: Awareness, Utilization and Barriers.

INTRODUCTION: World population of elderly is increasing at a fast pace. The number of elderly in India has increased by 54.77% in the last 15 years. A number of social security measures have been taken by Indian government. AIM: To assess awareness, utilization and barriers faced while utilizing social security schemes by elderly in a secondary care hospital situated in a rural area in Delhi, India. MATERIALS AND METHODS: A cross-sectional study was conducted among 360 individuals aged 60 years and above in a secondary care hospital situated in a rural area in Delhi. A pre-tested, semi-structured schedule prepared in local language was used. Data was analysed using SPSS software (version 17.0). Chi-square test was used to observe any statistical association between categorical variables. The results were considered statistically significant if p-value was less than 0.05. RESULTS: A majority of study subjects were females (54.2%), Hindu (89.7%), married (60.3%) and were not engaged in any occupation (82.8%). Awareness about Indira Gandhi National Old Age Pension Scheme (IGNOAPS) was present among 286 (79.4%) and Annapurna scheme in 193 (53.6%) subjects. Among 223 subjects who were below poverty line, 179 (80.3%) were aware of IGNOAPS; while, 112 (50.2%) were utilizing the scheme. There was no association of awareness with education status, occupation, religion, family type, marital status and caste (p>0.05). Corruption and tedious administrative formalities were major barriers reported. CONCLUSION: Awareness generation, provision of information on how to approach the concerned authority for utilizing the scheme and ease of administrative procedures should be an integral part of any social security scheme or measure. In the present study, about 79.4% of elderly were aware and 45% of the eligible subjects were utilizing pension scheme. Major barriers reported in utilization of schemes were corruption and tedious administrative procedures.

Mobile phone use and possible cancer risk: Current perspectives in India.

Mobile communication is now essentially ruling our daily lives through better connectivity and intelligent smartphone services. There has been a tremendous growth in Indian communication industry along with growing concerns regarding health effects of mobile radiation exposure. Concerns posed are especially regarding carcinogenesis and other health-related effects of mobile radiation exposure. In the effort to establish or refute any such concerns, many studies have been undertaken in the past three decades, mostly case-control designs or cross-sectional surveys. However, most of them considerably failed to establish causal association primarily owing to potential biases and errors in their conduct and analysis. Past cohort studies have provided contradictory results leading to continued uncertainty regarding tumorigenic potential of mobile radiation exposure. In India, there remains a huge knowledge gap pertaining to this particular topic and only few studies are presently underway such as the Indian Council of Medical Research (ICMR) cell phone study in the National capital region (NCR). International Agency for Research on Cancer (IARC) has classified radiofrequency electromagnetic fields associated with wireless phone use as possibly carcinogenic to humans (Group 2B), causing major concerns worldwide among mobile companies and subscribers equivocally. The World Health Organization (WHO) is presently carrying formal risk assessment of all studied health outcomes from radio frequency field's exposures and is likely to publish it by the year 2016.

Workplace violence against resident doctors in a tertiary care hospital in Delhi.

BACKGROUND: Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. METHODS: This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. RESULTS: Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. CONCLUSIONS: A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.

Prevalence of Risk Factors for Chronic Non-communicable Diseases Using WHO Steps Approach in an Adult Population in Delhi.

OBJECTIVE: The burden of non-communicable diseases (NCDs) is increasing worldwide largely due to prevalence of various risk factors, which can be controlled. Therefore, the present study was undertaken to measure the prevalence of major preventable risk factors for chronic non-communicable diseases in an urban resettlement colony of Delhi, using STEPS approach. MATERIALS AND METHODS: A cross-sectional study, that included a random sample of 200 adults, was conducted. A study tool based on the WHO STEPS questionnaire for assessing non-communicable diseases and their risk factors was used. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Anthropometric measurements of the participants were also taken. Data was analyzed using SPSS version 17. RESULTS: Out of the 200 participants, 26% (n = 52) were consuming alcohol and 17% (n = 34) were smoking. Majority (77.5%) had a raised waist circumference, and more than two-thirds were either overweight or obese. Fasting blood sugar levels were found to be raised in 18% of the study population. More than third participants had raised systolic and diastolic blood pressures and abnormal lipid profiles. More males were found to be overweight in comparison to females (P < 0.01), but in contrast, obesity (P < 0.05) and raised waist circumference (P < 0.001) were more common in females. Tobacco use was more common in lower class (P < 0.05), whereas obesity was commoner in the upper socio-economic class (P < 0.05). CONCLUSIONS: Study showed a high burden of risk factors for NCDs in the study population, pointing towards changing disease epidemiology of non-communicable diseases in India.

Occupational hazard exposure and general health profile of welders in rural Delhi.

BACKGROUND: Welding is a common industrial process associated with various health hazards. The aspect of duration of hazard exposure among welders at their workplace has been studied to limited extent in India. OBJECTIVE: To assess the duration of occupational hazard exposure and its association with symptoms among the welders. MATERIALS AND METHODS: A cross-sectional study was conducted amongst 106 welders in North Delhi. Data was collected using a questionnaire containing items to assess the socio-demographic profile, their medical history and individual hazard exposure. RESULTS: Majority of them were involved in skilled/semi-skilled job (n = 99; 93%). The predominant nature of work for majority was manual. More than half reported their work to be physically hard (n = 56; 53%), involves much lifting of weight (n = 61; 57%), and is dangerous (n = 59; 56%). Dust/smoke followed by noise was reported to be most common hazards at the workplace by them. Most of them were suffering from eye related symptoms (n = 63; 59%) followed by skin conditions (n = 28; 26%). Skin diseases were reported to be significantly common among group of welders who were exposed to dust and radiation for ≥4 hours in a day (P < 0.05). CONCLUSIONS: Nearly half of the welders found their job to be dangerous and were being exposed to at least one hazardous substance at their workplace. Majority of them complained of eye symptoms. There is a need for health and safety training of this economically productive group.

Effect of life skills training on physical activity patterns amongst school adolescents in Delhi: a non-randomized interventional study.

BACKGROUND: Effect of life skills on physical activity behavior of adolescents is little explored. OBJECTIVE: To assess impact of life-skills training on the level of physical activity amongst adolescents. METHODS: A nonrandomized interventional study with a control group. All students studying in Class IX and XI of two schools in Delhi were included. Data was collected at baseline, 15 days and 3 months after the life-skills training. Two life-skills training sessions were conducted for each standard following collection of baseline data. RESULTS: There were 180 students in the intervention and 183 students in the control group. A significant increase was noted in the level of light-moderate, vigorous physical activity, and stretching and strengthening exercises (p<0.001) in an intervention group over the period of 3 months following the training. The number of students enrolled in physical education classes also increased. CONCLUSIONS: A skills-based approach helped to improve the level of physical activity amongst the school adolescents.

Stage at diagnosis and delay in seeking medical care among women with breast cancer, delhi, India.

BACKGROUND: Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease. OBJECTIVES: The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India. PATIENTS AND METHODS: This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer "detected in surgery Out Patient Department (OPD) from January 2007 to December 2009" at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X(2), Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P < 0.05). RESULTS: the mean age of women was 46.99 years. 38.4% of women were ≤ 40 years. 61% of women were in stage IV of cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P < 005). CONCLUSIONS: A significant association was found between ages of women with their delays in consultation. Delay is still prevalent amongst women with breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

Low back pain and associated risk factors among undergraduate students of a medical college in Delhi.

CONTEXT: Low back pain (LBP) is the most common orthopedic problem worldwide and is known to affect both younger and older adults. The stressful and time consuming curriculum of medical students predisposes them to this problem. Few statistics are available on prevalence rates of LBP among medical students in India. This study assesses the prevalence and risk factors of LBP in students of a medical college in Delhi. METHODS: A cross-sectional study was carried out in a medical college in Delhi. The study subjects (n = 160; 100% participation) were selected via stratified random sampling from all undergraduate medical students (aged 17-25 years). A validated questionnaire was used to collect the data. RESULTS: The overall prevalence of LBP among the students over the past one year was 47.5% (n = 76) with a prevalence of 32.5% at the time of data collection. Prevalence among males and females was 45.3% and 50%, respectively. Significant associations were found between LBP in the past year and coffee drinking (Regular = 57%, Occasional = 38.9%, Never = 65.2%, χ2 = 7.24, P= 0.02), body posture (Normal = 32.6%, Abnormal = 75%, χ2 = 18.97, P < 0.001), place of study (Study table = 33.8%, Bed = 58.6, Both = 61.5% χ2 = 10.51, P = 0.01), family history of LBP (Present = 75%, Absent = 38.3%, χ2 = 16.17, P < 0.001) and carrying backpacks (Regular = 50%, Occasional = 33%, Never = 0%, χ2 = 16.17, P < 0.001). The mean scores of depression (2.7 vs. 1.6), anxiety (3.5 vs 1.9), and monotonous work (3.9 vs. 1.8) were found to be significantly higher in group with LBP than in the non-LBP group. However, no association with LBP was seen for weight lifting, watching television/working on computers, driving, wearing heels, or body mass index. DISCUSSION: The high prevalence of LBP among medical students and its association with poor study habits, lifestyle habits, and psychological factors highlight a need for life skills training, education, counseling, and restructuring of the medical curriculum.

Knowledge, attitude, and level of physical activity among medical undergraduate students in Delhi.

INTRODUCTION: Physical inactivity has been implicated as a major risk factor for cardiovascular diseases. The healthy lifestyle of medical students could facilitate the formation of healthy physicians who is more likely to give effective preventive counseling to their patients. Therefore, this study was undertaken to assess the knowledge, attitude, and pattern of the physical activity among the medical students. MATERIALS AND METHODS: A cross-sectional study was conducted amongst 161 eligible sixth semester medical undergraduate students. A pretested questionnaire was used to collect the data. Anthropometric measurements were also taken. The data were fed and coded in Microsoft Excel 2007 and analyzed using SPSS 17.0 and Epi Info software of World Health Organization. RESULTS: Knowledge regarding different types of exercise and anthropometric variables was fairly low among the study participants. Only 9.3% of the students were aware of the recommended level of the physical activity but nearly all (96.27%) were aware of the benefits of it. The attitude of the participants toward the physical activity was favorable, yet only one-third (32.3%) subjects adhered to recommended guidelines. Boys (39.8%) were found to be significantly more active than girls (20.6%) (P = 0.01). CONCLUSION: The knowledge and practices regarding the physical activity was found to be low amongst the medical students. There is a need to provide an enabling environment for promoting the physical activity amongst them so that can inculcate the same in their patients.